Rates of Gonorrhea Rise After a Long Decline

By LAWRENCE K. ALTMAN

Published: December 6, 2000

Gonorrhea rates in the United States have increased for two consecutive years, reversing a downward trend that had continued since the mid-1970's, federal health officials said yesterday.

Though the rise in rates reflects wider use of improved tests to screen for the bacterial infection and more thorough reporting, the increase needs to be addressed in public health programs, said Dr. Judy Wasserheit, who directs the program for sexually transmitted diseases at the Centers for Disease Control and Prevention, a federal agency in Atlanta.

Dr. Wasserheit said in a telephone interview that the reversed trend for gonorrhea was ''extremely disturbing'' and that it ''should serve as a wake-up call'' about the seriousness of sexually transmitted diseases that can cause infertility and other serious complications.

The cause of the increase is unclear.

After falling steadily for more than 20 years, the rates for gonorrhea increased 9 percent from 1997 to 1999, officials at the centers said. The rate peaked at 467.7 cases per 100,000 people in 1975, then fell steadily in all regions by 72 percent until stabilizing at rates of 123.2 in 1996 and 122.0 in 1997. The rate is now 133.2, with a total of 360,078 cases.

Gonorrhea rates are now highest in the South, probably because of high poverty and low access to quality health and preventive care, said Dr. Ron Valdiserri, an official at the disease control agency.

Dr. Wasserheit and other health workers released the new figures at a meeting on sexually transmitted diseases sponsored by the centers and the American Social Health Association in Milwaukee this week. Participants are trying to increase public awareness, testing and surveillance, and to give people with such diseases better access to care. The meeting also is aimed at helping the disease control agency eliminate syphilis from the United States. Syphilis rates reached a record low last year, officials said.

The centers also released findings from the first national survey on human papilloma virus, or H.P.V. It is believed to be the most common sexually transmitted infection among young, sexually active people, but the agency did not specify the age range. The 30 types of the virus have been linked to several diseases like genital warts and cancer of the cervix, penis and anus. Papilloma virus accounts for 93 percent of cervical cancer, and one type, H.P.V.-16, accounts for half of all such cases.

In many, the immune system clears the virus without causing illness. A major question is why a large percentage of women are infected with H.P.V. but only a much smaller percentage develop cervical cancer.

The national survey involved 7,218 participants who, from 1991 to 1994, had their blood tested for H.P.V.-16.

The survey found H.P.V.-16 infection in 17.9 percent of women of all races compared with 8 percent of men. Black women ages 20 to 29 had the highest prevalence, 36 percent, and the prevalence among blacks overall was 19.1 percent, compared with 12.5 percent in whites.

The prevalence of H.P.V.-16 increased with the number of an individual's lifetime sex partners: 7 percent of people with one lifetime sex partner were infected, compared with 20.1 percent of people with 50 or more lifetime sex partners.

The centers also reported that another sexually transmitted infection that is caused by the chlamydia bacteria remains the most frequently reported infectious disease.

A total of 659,441 chlamydia cases were reported to the centers, with a rate of 254.1 cases per 100,000 people.

Both infections are believed to be underreported. Most of those who are infected with chlamydia do not know it because they experience no symptoms. The disease control agency estimates that three million Americans are infected with chlamydia each year.

No new syphilis cases were reported last year in 79 percent of the 3,115 counties in this country. But Dr. Valdiserri warned that syphilis remained a significant health threat in specific areas. For example, small outbreaks were reported among gay men in Los Angeles and Seattle.